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In this issue
Premier Safety Web site
October 2003
Dear Colleague:
Healthcare associated infections are the fourth leading cause of cause of death after heart disease, cancer and stroke and represent almost 90,000 deaths per year.
In recognition of National Infection Control Week, October 20 to 24, we have focused our news on risks and prevention strategies for healthcare-associated infections. We applaud the patient safety and infection control professionals that are committed to working together to reduce risks to our patients.
Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute
News
- New FAQ: JCAHO clarifies safety goal on infections and hand hygiene
- NQF to publish measures of nursing care; nursing education impacts care
- FDA issues SARS blood screening advice
- Hepatitis outbreaks linked to unsafe injection practices
- Healthcare-associated infection prevention requires partnerships in infection control, risk management, quality
- Quality initiative moves forward; data available on CMS Web site
Safety tools
- CDC Resources and Pink Book on Vaccine-Preventable Diseases
- OSHA bulletins: CBRN respirators and West Nile virus
- AHRQ guide: Adult preventive care
New FAQ: JCAHO clarifies safety goal on infections and hand hygiene
To assist in implementation efforts for 2004, the Joint Commission has issued its long-awaited clarification of the newest National Patient Safety Goal (NPSG). The frequently asked questions (FAQ) document addresses questions related to both sentinel events involving infection and expected adherence to CDC guidelines for hand hygiene.
Downloads and links
- FAQ NPSG Goal 7 (36 KB)
- CDC guidelines
NQF to publish measures of nursing care; nursing education affects care
The National Quality Forum (NQF) expects to finalize a set of consensus standards for measuring nursing care in hospitals. The draft consensus report, "National Voluntary Consensus Standards for Nursing-Sensitive Performance Measurement," is available for comment until October 31, 2003.
The 13 measures are based on "a growing body of evidence that demonstrates the influence of nursing personnel -- and the stability of nursing personnel -- on patient outcomes, hospital costs and the professional atmosphere in which care is provided," wrote authors in a draft of the standards. According to the NQF, the measures of nursing care were sufficiently supported by scientific data to gain the endorsement of various committees representing consumers, purchasers, researchers, providers and health plans. They include prevalence of conditions or events suffered as a result of a hospital stay such as pneumonia, pressure ulcers and falls. Other measures expand on that theme. One asks for the percentage of surgical patients who died after experiencing a complication while hospitalized, and another for the rate of pneumonia associated with the use of ventilators in the intensive-care unit. The standards also include total work hours by nurses per 1,000 patient days.
Surgical mortality and nurse education
A recent study published in the Journal of the American Medical Association (JAMA) demonstrated that death rates for surgical patients are higher at hospitals that employ a lower percentage of nurses with at least a bachelor's degree. In a review of 168 Pennsylvania hospitals, the facilities that had fewer than 10 percent of nurses with at least a bachelor's degree reported almost 3 percent mortality among patients undergoing general, orthopedic or vascular surgery. By comparison, hospitals at which more than 70 percent of nurses had at least a bachelor's degree, the mortality rate was 1.5 percent.
Why the disparity? Better-educated nurses tend to be more proficient in critical thinking, according to Linda Aiken, a University of Pennsylvania nursing and sociology professor. Rita Turley, president of the American Organization of Nurse Executives, said the study is a good resource for hospital and nurse leaders, but needs to be replicated and expanded for validation. Turley added that while hospitals promote and support educational advancement for their nurses, many baccalaureate nursing programs cannot accommodate all of the students who would like to enter due to a severe shortage of nursing faculty. In 2000, about one-third of all nurses in U.S. hospitals had associate's degrees and another third had bachelor's degrees.
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NQF National voluntary consensus standards for nursing-sensitive
performance measurement (56 KB)
- Appendix A & B (82 KB)
- Appendix C (78 KB)
- Appendix D & E (49 KB)
- Educational levels and surgical patient mortality (108 KB)
More information:
- NQF safe practices (316 KB)
- NQF quality measures (27 KB)
FDA issues SARS blood screening advice
The Food and Drug Administration (FDA) has issued revised recommendations for use by blood establishments to assess blood donor suitability and blood product safety in suspected cases of severe acute respiratory syndrome (SARS) or SARS exposure. The document updates earlier recommendations, clarifying whether blood establishments should continue to screen donors on the basis of travel to SARS-affected areas during non-SARS alert time periods.
In the event that the CDC has identified SARS-affected areas within the previous 90 days, the guidance recommends asking donors whether they have been ill with SARS or suspected SARS in the past 28 days, and whether they have cared for or had direct contact with body fluids of a person with SARS or suspected SARS in the past 14 days. Further, the questions should be discontinued after CDC has lifted all travel alerts for SARS affected areas. In the event the CDC has identified SARS-affected areas within the previous 14 days, the guidance recommends asking donors whether they have traveled to or resided in SARS-affected areas within the previous 14 days, and providing them with a list of SARS-affected areas as updated by CDC. It says the question should be discontinued 14 days after the CDC has lifted the travel alert for a geographic area. The guidance document can be found at FDA Web site listed below.
- FDA Recommendations on SARS (37 KB)
- FDA Web site http://www.fda.gov/cber/whatsnew.htm
Hepatitis outbreaks linked to unsafe injection practices
Four recent large outbreaks of hepatitis B (HBV) and hepatitis C (HCV) in U.S. outpatient settings could have been prevented by adherence to basic principles of aseptic technique, according to the Centers for Disease Control and Prevention (CDC). The investigation of each outbreak suggested that unsafe injection practices, primarily reuse of syringes and needles or contamination of multiple-dose medication vials, led to patient-to-patient transmission. To prevent transmission of bloodborne pathogens, all healthcare workers should adhere to recommended standard precautions and fundamental infection control principles, including safe injection practices and appropriate aseptic techniques. These four outbreaks are among the largest healthcare-related viral hepatitis outbreaks reported in the United States and share several common characteristics:
- All occurred in outpatient settings and were reported to public health authorities by clinicians who suspected these infections might have been healthcare-related.
- Transmission probably occurred indirectly from patient to patient after exposure to injection equipment that was contaminated with the blood of one or more source patients.
- All of these outbreaks could have been prevented by adherence to basic principles of aseptic technique for the preparation and administration of parenteral medications.
- Transmission of hepatitis (85 KB)
Healthcare-associated infection prevention requires partnerships in infection control, risk management, quality
Healthcare infection control professionals (ICPs) should partner with risk managers (RM) to decrease the incidence of healthcare-associated infections (HAI), said speakers at a September 23, 2003, audio conference on infection control sponsored by the American Society for Healthcare Risk Management (ASHRM). National surveillance data of HAIs indicate that facilities with the most success in reducing their infection rates have fostered partnerships and support among various infection control groups.
In addition to ICPs and RMs, groups that should be involved in infection control prevention include nurses, physicians, support staff such as housekeeping, and administration. Tammy Lundstrom MD, vice president and chief quality and safety officer of the Detroit Medical Center and clinical consultant for Premiers Safety Institute, joined Arjun Srinivasan MD, Division of Healthcare Quality Promotion, Centers for Disease Control, and Russ Olmsted, MPH, CIC, epidemiologist at St. Joseph Mercy Health System, Trinity-Health, Ann Arbor to address the challenges and opportunities to reduce infection. HAIs -- which affect an estimated 5 percent to 6 percent of all hospitalized patients -- contribute to 90,000 deaths per year. As one of its 2004 National Patient Safety Goals, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will require facilities to manage as a sentinel event all cases of unanticipated death or major permanent loss of function associated with HAIs. Results from an instant poll taken during the ASHRM audio conference suggest that these events may currently be underreported. Approximately 3 percent of polled participants said that their facilities had identified a sentinel event associated with HAI in the past few years. Recently published FAQs from JCAHO clarify the distinction of patients dying from infection, versus with infection. See related story on JCAHO FAQ.
- Information on purchasing a tape or CD of the audio conference is posted on ASHRM's Web site at http://www.ashrm.org; click on the link for audio conferences.
- JCHAO FAQ patient safety goal #7 (36 KB)
Quality initiative moves forward; data available on CMS Web site
The first performance data for hospitals participating in The Quality Initiative: A Public Resource on Hospital Performance are available from the Web site of the Centers for Medicare and Medicaid Services (CMS). The American Hospital Association (AHA), Federation of American Hospitals, Association of American Medical Colleges and other initiative partners unveiled the Web site at a press briefing on October 9 in Washington DC.
To date, 1,717 hospitals in all 50 states, the District of Columbia and Puerto Rico have pledged to participate. Although data are displayed for 415 hospitals in the initial posting intended primarily for hospitals and clinicians, more than 1,000 hospitals have begun submitting data to CMS for the next posting in February 2004. Hospitals have until November 15, 2003 to submit data for that posting. Meanwhile, the hospital groups said they will work to increase the number of hospitals participating, expand on the starter set of measures, and determine how best to make data meaningful and useful to the public. For a complete list of hospitals participating in the initiative, visit http://www.aha.org and click on the Quality Initiative icon.
- Retrieval of data from CMS: Link to http://www.cms.hhs.gov/quality/hospital/. Follow the link to National Voluntary Reporting to retrieve information by state, city or hospital.
Safety tools
- CDC Resources and Pink Book on Vaccine-Preventable Diseases
- OSHA bulletins: CBRN respirators and West Nile virus
- AHRQ guide: Adult preventive care
CDC Resources and Pink Book on vaccine-preventable diseases
The Centers for Disease Control and Prevention (CDC) has a wide range of resources from CDCs National Immunization Program (NIP) Web site (www.cdc.gov/nip.) The Pink Book Epidemiology and Prevention of Vaccine Preventable Diseases,” the 7th edition from 2002, is now in its second printing. The book is available for download or purchase at http://www.cdc.gov/nip/publications/pink/default.htm.
- For more information on influenza immunization, go to Premier Safety Institute Influenza resources.
OSHA bulletins: CBRN respirators and West Nile virus
Two new safety and health information bulletins are available on the Occupational Health and Safety Administrations (OSHA) Web site. The bulletin, entitled "Chemical, Biological, Radiological, and Nuclear (CBRN) Warfare Agents Escape Respirators," was developed to provide employers with information on helping to protect workers from injuries and illnesses resulting from possible terrorist incidents related to chemical, biological, radiological, or nuclear attacks.
The agency also has published a bulletin to help protect workers who may be exposed to the West Nile virus. Workplace Precautions Against West Nile Virus discusses symptoms of the virus, what occupations are at risk, and various safeguards employers can take to combat workplace exposure.
AHRQ guide: Adult preventive care
The Agency for Healthcare Research and Quality (AHRQ) issued an updated guide on the recommended preventive health care services for adults. "The Pocket Guide to Good Health for Adults," based on the latest recommendations of the U.S. Preventive Services Task Force, is intended to remind providers to deliver appropriate preventive services while involving patients directly in their preventive care. It includes recommendations on screening tests and immunizations, questions for patients to ask health care providers, and resources for additional information.
- The guide is available in English at
http://www.ahrq.gov/ppip/adguide/ - and in Spanish at
http://www.ahrq.gov/ppip/spadguide
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Editorial team
Gina Pugliese, RN, MS editor
Judene Bartley, MS, MPH, associate editor
Donna Bernstein, MPH, marketing consultant
John Hall, BSJ, contributor
Derek Kleckner, BA, Web master
Judith Luca, RN, BSN, contributor
About Premier
Premier, Inc. is a healthcare alliance entirely owned by 200 of the nation's leading not-for-profit hospital and healthcare systems. These systems operate or are affiliated with 1,500 hospital facilities and hundreds of other healthcare sites. Premier provides an array of resources supporting health services delivery, including clinical and operational comparative data applications for quality/safety performance improvement, group purchasing and supply chain services, and insurance programs. The Centers for Medicare and Medicaid Services (CMS) has recently partnered with Premier for a three-year quality incentive demonstration project. Participating hospitals using Premiers Perspective Online database can receive recognition and additional Medicare payment when they meet or exceed specific quality measures.